Congenital diaphragmatic hernia: a neonatologist’s perspective. A narrative review

Congenital diaphragmatic hernia (CDH) is a complex anomaly characterized by a defect in the diaphragm that allows abdominal organs to herniate into the thoracic cavity, leading to pulmonary hypoplasia, pulmonary hypertension, and cardiac dysfunction. Emerging evidence suggests that cardiac dysfunction plays a key role in CDH pathophysiology. From a neonatologist’s perspective, early recognition through prenatal imaging is essential for risk stratification and planning perinatal management. Prognostic indices, such as lung-to-head ratio, liver herniation, observed-to-expected total fetal lung volume, and stomach position, provide valuable information on severity and expected outcomes. In the delivery room, stabilization focuses on gentle ventilation strategies and preventing pulmonary barotrauma, with careful monitoring of oxygenation and hemodynamics. Postnatally, multidisciplinary care is crucial, encompassing respiratory support, pulmonary hypertension management, hemodynamic support, nutritional support, and timing surgical repair after clinical stabilization. Despite advances in prenatal diagnosis and neonatal intensive care, CDH remains associated with significant morbidity and mortality, underscoring the importance of ongoing research and individualized patient management.